NIH Updates Its Strategy to Combat Obesity

Research spending has been on the upswing, but so has the obesity epidemic.

In the years since NIH first crafted a strategic plan to guide its policy and practices for funding research into obesity, the number of Americans meeting the criteria for obesity rose from more than 61 million to more than 72 million. The percentage of obese American children grew from 16% to 17% of total population. And the estimate for obesity-related medical costs escalated from $117 billion to $147 billion.

The NIH says those changes and others over the past near-decade prompted it to update the “Strategic Plan for Obesity Research” it completed in 2004. The new plan, released March 31, is NIH’s effort to shape the direction of obesity research as well as encourage nonscientific community anti-obesity efforts in hopes of combating the epidemic.

“The majority of grants funded by the NIH are those initiated by investigators, but the NIH may also propose new initiatives based on the research opportunities outlined in the strategic plan and on available resources for funding,” Catherine (Cay) Loria, Ph.D., nutritional epidemiologist in the NHLBI’s Division of Cardiovascular Sciences, told GEN. “Thus, the Strategic Plan should stimulate meaningful research and facilitate efficient use of obesity-related research dollars.”

Dr. Loria, who is also co-chair of the NHLBI Obesity Working Group and a member of the NIH Obesity Research Task Force leadership group, which developed the strategic plan, added, “The strategic plan reflects both the complexity of obesity and the exciting opportunities that have emerged from research advances since the NIH published its first strategic plan on this major public health challenge in 2004.”

Basic Research and Translational Medicine

One key priority for future action, according to the strategic plan, is for researchers to discover fundamental biologic processes that regulate body weight and influence behavior. The plan defines that to include helping develop more effective lifestyle interventions and pinpointing potential candidates for new drug development.

Another basic research avenue recommended by the report is to “explore the use of imaging technology for obesity research, including new tools to probe neuronal pathways controlling eating behavior, investigate lipid metabolism and inflammation in tissues, or image energy expenditure.”

Imaging is also recommended as a tool for regulating food portions. According to the plan, NIH should “encourage development of improved mobile phone or camera devices that can use digital pictures and image recognition technology to accurately identify foods and portion sizes for purposes of advancing food record dietary assessment methods.”

In addition to all that basic research, the plan also calls for scientists to advance translational research into obesity. This includes developing novel screens to identify small molecules that can modulate energy-balance pathways; developing methods to monitor mitochondrial biogenesis and function in vivo; establishing and characterizing new animal models for studying obesity and assessing therapeutic approaches to it; and examining the role that variation in underlying genetic factors plays for promoting obesity in humans.

Going Beyond the Biology of Disease

“As the NIH pursues promising avenues and exciting new scientific opportunities, this updated Strategic Plan for NIH Obesity Research will serve as a guide to accelerate progress in obesity research, from basic discovery to application and integration of prevention and treatment strategies in clinical practice and community settings, with the goals of extending healthy life and reducing the burdens of illness and disability,” the 32-page plan concluded.

Other priorities laid out in the new strategic plan include:

• Understanding the factors that contribute to obesity and its consequences: This includes not just biological factors but behavioral, social, cultural, and environmental factors as well.

• Designing new interventions for achieving and maintaining a healthy weight: This covers behavioral and environmental approaches to lifestyle change, from individual- and family-based to community-wide strategies as well as medical and surgical interventions.

• Facilitating research results into community programs and medical practice: According to the plan, “A number of areas of NIH-supported obesity research may benefit from public-private partnerships and other collaborative efforts involving industries, schools, healthcare providers, community organizations, other government agencies, and other partners.”

• Evaluating promising strategies for obesity prevention and treatment in real-world settings and diverse populations: Among NIH’s suggestions are health surveillance, improved healthcare delivery, and comparative effectiveness, as well as cost-effectiveness analyses of interventions.

“Further areas of opportunity include the development of strategies for implementing promising programs broadly in communities and maximizing their reach, evaluation of the effects of policies, and exploration of communication strategies to effectively disseminate science-based health information to diverse populations,” the strategic plan stated.

Will the Money Lead to Success?

The ’04 plan offered its own set of themes—essentially, broader and interrelated goals for what NIH should achieve in obesity research. This included studies on preventing and treating obesity through lifestyle modification as well as pharmacologic, surgical, or other medical approaches and research toward breaking the link between obesity and its associated health conditions.

The NIH’s current concern reflects the growing cost of studying obesity as well as the growing epidemic. Between fiscal years 2007 and 2010, spending on obesity research swelled by nearly two-thirds, from $595 million to $971 million, according to the NIH.

By contrast, spending on diabetes, which is linked to obesity, increased by 12% between FY ’07 and FY ’10, from $1.069 billion to $1.199 billion. The costliest research category, cancer, saw a spending rise of 19% during that same period, from $5.549 billion to $6.626 billion.

According to Dr. Loria, advances in basic and clinical obesity research over the past decade have served as a catalyst for an increasing number of researchers who devote time and efforts to obesity-related research; research that has been enabled with no small help from NIH research dollars. The 2009 and 2010 figures for obesity research spending—$862 million and $971 million, respectively—were inflated by the availability of millions of additional research dollars through the $814 billion American Recovery and Reinvestment Act (ARRA), the so-called stimulus measure enacted by President Obama shortly after he took office. ARRA was the source of an additional $117 million in obesity grants in FY 2009 and $147 million in FY 2010.

Subtract the ARRA money and you still have significantly higher spending on obesity research than the $661 million spent in FY 2006, let alone the lower FY 2007 level. The NIH budget accounted for $745 million in obesity grants for FY ’09 and $824 million in FY ’10. For the current fiscal year, which began October 1, 2010, NIH estimates it will spend $823 million on obesity research, a figure it predicted would rise to $837 million in FY 2012.

President Obama on Friday signed a continuing resolution that cuts NIH funding by $260 million. The cut is a compromise between the Republican-controlled House of Representatives, which proposed cutting NIH funding by $1.6 billion, and the Democratic-controlled Senate, which sought to freeze NIH spending at the FY 2010 level.

Yet the new strategic plan didn’t delve into the issue of what money will be available. Dr. Loria said the task force will monitor the state of funding as well as the state of obesity research initiatives, “to identify areas that are critical but understudied or show the most promise for addressing the obesity public health challenge.”

The 2004 plan did touch upon funding, but offered readers little more than a pitch to check out the funding opportunities available on the NIH Obesity Research website, and a promise: “Investigator-initiated research represents a substantial portion of the NIH funding portfolio, and the NIH will continue vigorous support of these efforts.”

How funding trends will affect the ability of researchers to study obesity and help fight it over the next few years is worthy of significant attention, and not just the next time the agency gets around to writing a strategic plan. The more NIH can show results from its research spending, the better it can rebut lawmakers and other critics intent on reducing its budgets, not to mention justify future funding increases.

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